Quick Facts
Generic NameAsenapine
Brand NameSaphris
Drug ClassSGA
FDA Approved2009
Starting Dose5mg sublingual twice daily
Typical Range5–10mg twice daily
Max Dose20mg/day
Half-Life24 hours
MetabolismCYP1A2 (major), UGT
Generic Available2020
What Is Saphris?
Asenapine (brand name Saphris) is a second-generation (atypical) antipsychotic (SGA) prescribed for schizophrenia, bipolar mania, and other psychiatric conditions. SUBLINGUAL administration only — must dissolve under tongue (10 min), no food/water for 10 min after. Oral bioavailability <2% if swallowed (bypasses first-pass). Black cherry flavored. Oral hypoesthesia (tongue numbness) is common and unique to this drug. Moderate weight gain. Transdermal patch (Secuado) also available.
At Psychiatry Telemed, asenapine is prescribed and monitored by board-certified psychiatrists who understand the nuances of SGA pharmacology — selecting the right dose, managing side effects, monitoring drug interactions, and optimizing your treatment through consistent monthly medication management appointments.
Asenapine (Saphris) — SGA medication for psychiatric care
ManufacturerAllergan (originally Organon)
How Saphris Affects Neurotransmitters
How Saphris Works
Asenapine has high affinity for multiple serotonin, dopamine, alpha-adrenergic, and histamine receptors. Its 5-HT2A/D2 affinity ratio is among the highest of any antipsychotic, which may contribute to its relatively favorable EPS profile.
Efficacy: Saphris vs. Comparators
Efficacy Comparison
Response & remission rates vs. comparators (Cipriani et al. meta-analysis)
Data from published meta-analyses. Individual response may vary.
Conditions Treated with Saphris
Bipolar Mania
FDA-approved for acute bipolar mania (monotherapy or adjunct).
Learn About Bipolar ManiaConsidering Saphris?
Board-certified psychiatrists can determine if asenapine is right for you.
Dosage Information
| Indication | Starting Dose | Typical Range | Maximum |
|---|---|---|---|
| Schizophrenia | 5mg sublingual twice daily | 5–10mg twice daily | 20mg/day |
| Bipolar Mania | 5mg sublingual twice daily | 5–10mg twice daily | 20mg/day |
Brain Regions Targeted by Saphris
Side Effects
Like all medications, asenapine has potential side effects. Most are mild, occur early in treatment, and resolve within 1–2 weeks. Your psychiatrist monitors at every appointment.
Common Side Effects
SomnolenceOral HypoesthesiaDizzinessEPSWeight GainAkathisia
Less Common
Dry MouthToothacheVomitingInsomniaFatigue
Serious (Seek Immediate Help)
Neuroleptic Malignant SyndromeTardive DyskinesiaAngioedemaSevere Allergic ReactionMetabolic Syndrome
Side Effect Profile: Saphris vs. Class Average
Side Effect Profile
Incidence rates from FDA prescribing information vs. class average
Percentages from clinical trial data. Actual experience may differ.
⚠️ FDA Black Box Warning
Elderly dementia patients: increased mortality risk.
Drug Interactions
Major Interactions
Fluvoxamine (CYP1A2 inhibitor — avoid or reduce dose), CNS depressants, antihypertensives
CYP Metabolism
Substrate of CYP1A2 and UGT1A4. Fluvoxamine (potent CYP1A2 inhibitor) significantly increases asenapine levels.
Alcohol
Avoid alcohol during asenapine treatment. Both affect the CNS, increasing sedation and impairing judgment.
Generic Versions & Cost
Generic asenapine available since 2020. Approximate cost: $15–40/month. FDA-certified bioequivalent to brand-name Saphris.
Starting Saphris: What to Expect
First Weeks
Asenapine is typically started at 5mg sublingual twice daily and increased gradually. Common initial side effects usually improve within 1–2 weeks. Full therapeutic benefit develops over 4–8 weeks.
When to Contact Your Psychiatrist
Contact your psychiatrist for: worsening depression/anxiety, thoughts of self-harm, unusual agitation, severe side effects, or any concerning changes.
Stopping Saphris Safely
Never stop asenapine abruptly. Your psychiatrist will develop a gradual tapering schedule to minimize discontinuation effects.
Timeline: When Saphris Starts Working
Timeline to Effectiveness
Expected improvement trajectory over the first 8 weeks
Based on clinical trial data. Full therapeutic effects may take 6–8 weeks.
Get Saphris from a Board-Certified Psychiatrist
At Psychiatry Telemed, asenapine is prescribed following comprehensive evaluation. All Florida via HIPAA-compliant telepsychiatry. 1–3 days. $299 eval, $149 follow-up.
Frequently Asked Questions
Prescribed for schizophrenia, bipolar mania.
Typically 2–4 weeks for initial improvement, 4–8 weeks for full benefit.
Common: somnolence, oral hypoesthesia, dizziness, eps, weight gain. Most resolve within 1–2 weeks.
No. Not habit-forming but should not be stopped abruptly — gradual tapering recommended.
SUBLINGUAL administration only — must dissolve under tongue (10 min), no food/water for 10 min after. Oral bioavailability <2% if swallowed (bypasses first-pass). Black cherry flavored. Oral hypoesthe
Alcohol should be avoided — increases sedation, impairs judgment, and may worsen symptoms.
Resources
Medical Disclaimer: Educational only. Consult a psychiatrist before starting/stopping medication. Crisis: call 988 or 911.
Last reviewed: